AAFP, Others Urge Hospitals to Stop Early Elective Deliveries

The AAFP, along with the American College of Obstetricians and Gynecologists (ACOG) and several other medical associations, sent a letter(www.magnetmail.net) on May 1 to 3,100-plus hospitals that provide maternity care, urging them to help eliminate nonmedically indicated deliveries before 39 weeks' gestation.

According to AAFP EVP Douglas Henley, M.D., the Academy and its partners sent the letter to advance HHS' Strong Start Initiative(innovation.cms.gov) by asking the hospitals to work to reduce the rate of elective deliveries performed before 39 weeks' gestation to less than 5 percent. Strong Start, said Henley, represents an extension of two of the recommendations the AAFP and ACOG made in the most recent list released as part of the American Board of Internal Medicine Foundation's Choosing Wisely campaign.

"The letter, in part, states that 'increasing evidence demonstrates that elective deliveries prior to full-term gestation put babies at risk, and established clinical guidelines now advise against performing early-term (37 or 38 weeks' gestation), nonmedically necessary deliveries,'" Henley told AAFP News Now, referring to a June 2012 statement by the American Hospital Association's Board of Trustees that is cited in the letter.

story highlights

The AAFP sent a letter on May 1 to 3,100-plus hospitals that provide maternity care, urging them to help eliminate nonmedically indicated deliveries before 39 weeks' gestation.

Part of HHS' Strong Start Initiative, the letter asks hospitals to work to reduce the rate of elective deliveries prior to full-term gestation to less than 5 percent.

AAFP EVP Douglas Henley, M.D., said Strong Start represents an extension of two of the Academy's recommendations released in the most recent Choosing Wisely list.

"We know, based upon evidence, that nonmedically necessary deliveries before 39 weeks' gestation can present an increased risk to babies born earlier than that," Henley said. "There will clearly always be, because of possible medical complications with the baby or mother, reasons to deliver earlier, but there are good reasons to avoid nonmedically necessary deliveries absent such medical indications."

Henley said Strong Start allows the AAFP to spread the message from the Choosing Wisely campaign to another important target audience.

"We felt we needed to direct that message to hospitals so that they can develop institutional policies that reflect what Choosing Wisely is already saying to the public and to doctors," he said. "These hospitals can set institutional policies that are directive to the nursing staff on OB floors, as well as to the other professional staff -- including the doctors who have privileges to deliver babies -- that this is an important patient safety and quality improvement issue, which the entire institution is setting as a goal to improve patient outcomes."

According to the Strong Start website, fewer early elective deliveries means

more mothers get safe, evidence-based care;

infants' chances for good physical and developmental health improve; and

costs for public and private payers decrease because fewer Caesarean sections need to be performed after failed inductions, there are fewer neonatal intensive care unit admissions, and the incidence of associated complications among newborns drops.

The letter suggests that hospitals without a documented hospital plan/policy in place to eliminate nonmedically indicated deliveries before 39 weeks "form a multidisciplinary team composed of obstetrical providers, nursing staff, administration and, as this is a public issue, potentially a (hospital) board member" to develop and implement such a policy.

In addition, the letter asks that hospitals voluntarily report early elective delivery data to a Hospital Engagement Network and/or post their delivery policy on their hospital website.